ERAS理念早期康复的医护患新模式在肩袖损伤关节镜术后的临床效果研究

Clinical effect of a new mode of early rehabilitation with ERAS concept on rotator cuff injury after arthroscopy

目的探讨医护患一体化术后加速康复(enhanced recovery after surgery,ERAS)模式对肩关节镜治疗肩袖损伤患者术后患肢功能康复训练中的自我效能及康复效果的影响。方法2020年4月至2021年4月首都医科大学附属北京世纪坛医院对实施肩关节镜手术治疗的肩袖损伤60例患者完成了随机对照研究,按照随机数字表,分为日常护理组(DN组,n=29)和快速康复组(ER组,n=31)。随访周期3个月,两组患者分别采用日常护理方案和医护患一体化ERAS方案进行术后康复,采用体格检查、康复自我效能量表、Constant-Murley量表评估两组患者临床效果差异。结果术后3个月,两组患者锻炼自我效能、应对自我效能、康复自我效能量表总分高于干预前,且ER组显著高于DN组,差异有统计学意义(P<0.05);在术后1周和术后3个月Constant-Murley量表评分上,与DN组相比,ER组显著偏高,差异有统计学意义(P<0.05);在术后3个月功能锻炼依从性上,ER组较DN组显著偏高,差异有统计学意义(P<0.05)。结论医护患一体化ERAS模式有助于提高关节镜下治疗肩袖损伤术后上肢康复训练自我效能水平,提升康复锻炼依从性,可较快恢复患肢机能。

Background Rotator cuff injury,also known as rotator cuff tear(RCT),is a common shoulder joint injury.Currently there is no unified standard for arthroscopic rehabilitation for RCT injury in terms of improving shoulder function,relieving pain and improving quality of life.Objective To explore the effect of medical care patient integration with enhanced recovery after surgery(ERAS)rehabilitation model on self-efficacy and rehabilitation effect of functional rehabilitation training of affected limbs after shoulder arthroscopy in patients with RCT.Methods From April 2020 to April 2021,a randomized controlled study with 60 patients was completed,and the follow-up period was 3 months(daily-nursing group:n=29;ERAS rehabilitation group:n=31).Postoperative rehabilitation of patients in the two groups was carried out by daily nursing regimen and medical-patient integration ERAS protocol,respectively.The clinical effects of the two groups were evaluated by physical examination,self-efficacy for rehabilitation outcome scale(SER),Constant-Murley scale.Results Three months after operation,the total scores of exercise self-efficacy,coping self-efficacy and rehabilitation self-efficacy in the two groups at last follow-up were higher than preoperatively,the experimental group was significantly higher than that in the control group(P<0.05);in the score of Constant-Murley scale 1-week and 3-months after surgery,the ERAS rehabilitation group was significantly higher than that in the Daily-nursing group,and the difference was statistically significant(P<0.05);the compliance of functional exercise in the experimental group was significantly higher than that in the control group 3 months after operation(P<0.05).Conclusion The integrated ERAS rehabilitation model of medical care and patients is helpful to improve the self-efficacy level of upper limb rehabilitation training after arthroscopic treatment of rotator cuff injury,enhance the compliance of rehabilitation exercise,and quickly restore the function of affected limbs.